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Insurance, Finances, Disability, Veterans Benefits Your finances, insurance, job issues, and veterans benefits

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Old Mon Jun 25, 2007, 02:06 PM
Rose Shifflett Rose Shifflett is offline
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Join Date: Jan 2007
Posts: 2
Insurance Denial for BMT

I was scheduled for my Bone Marrow Transplant for 6-14, had my Hickman line and my Portocath inserted on 6-13, had taken medicine for a week in preparation for it and had already started on Dilantin when I was informed that my insurance denied the pre-authorization for the bmt, so we had to check out of the hospitality house and go back home and my unrelated donor had to be put on hold! I received the letter from the insurance two days later and then a reviewed one the next day. I appealed it through a Bureau of Insurance and my transplant doctor (bless him)sent a 5-page letter with my appeal explaining that his regimen of Chemo is not a clinical trial but regular practice for people over 50. So I am back in the waiting chair, they have 10 days to reply. I just wondered if omething like this ever happened to anybody else and if maybethere are other resources I can turn to? Thanks, I really apreciate it. I have been blessed with great doctors and nurses and a wonderful support group with my friends and family and this forum, thank you everybody for sharing, it makes such a difference!

Rose 57 years dx 09-2006 with MDS RAEB10 rounds of Vidaza in preparation for BMT
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Old Tue Jun 26, 2007, 04:53 AM
Lisa V Lisa V is offline
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Join Date: Aug 2006
Location: Waimanalo, Hawaii
Posts: 401
Rose, I'm so sorry you've had this experience! It's hard enough psyching yourself up for a BMT without having to deal with whether or not some insurance company thinks you should have it or not. This should be a decision between you and the medical team. It makes me so angry that money should even enter into it, but of course it does.

We are Kaiser members and recently had to jump through all kinds of hoops in order to just get HLA testing done on my husband's siblings. We have no plans for a BMT at this time, but they wouldn't even approve the testing until we could show them we had a financial plan in place to deal with the expenses of a transplant if we did ever need to do it. The social worker said "We just want to be sure this isn't going to bankrupt you", to which I asked "But what if it does?" I couldn't get a straight answer to that one, but the bottom line is that if they don't think they can collect, they won't do it. There's something very wrong with this picture.
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-Lisa, husband Ken age 60 dx SAA 7/04, dx hypo MDS 1/06 w/finding of trisomy 8; 2 ATGs, partial remission, still using cyclosporine
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